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Volume 25, Number 6—June 2019
Research

Assessment of Economic Burden of Concurrent Measles and Rubella Outbreaks, Romania, 2011–2012

Joseph Njau1, Denisa Janta, Aurora Stanescu, Sarah S. Pallas, Adriana Pistol, Nino Khetsuriani2, Susan Reef, Daniel Ciurea, Cassandra Butu, Aaron S. Wallace, and Laura ZimmermanComments to Author 
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J. Njau, S.L. Pallas, S. Reef, A.S. Wallace, L. Zimmerman); National Public Health Institute, Bucharest, Romania (D. Janta, A. Stanescu, A. Pistol); Centers for Disease Control and Prevention, Tbilisi, Georgia (N. Khetsuriani); Center for Health Policies and Services, Bucharest (D. Ciurea); World Health Organization Country Office, Bucharest (C. Butu)

Main Article

Table 1

Definitions and data sources used for cost components during assessment of economic burden of concurrent measles and rubella outbreaks, Romania, 2011–2012*

Cost component Definition Data sources
Healthcare provider
 All reimbursements for diagnostic testing for measles and rubella, inpatient and outpatient care, emergency treatment, case management
 Reimbursement data from National Health Insurance House (CNAS) covering all registered government healthcare providers using the Romanian national clinical diagnosis codes associated with measles and rubella diagnoses, outpatient and inpatient care, and vaccinations (Appendix Table), as submitted by healthcare providers
National outbreak response
 Enhanced surveillance, laboratory diagnosis and confirmation, field activities such as case investigations, and outbreak response immunization, including actual expenses incurred for personnel, laboratory supplies, and vaccine doses provided to contacts of cases and to high-risk communities
 Interviews with key personnel, including the Director of the National Institute for Public Health, Romanian MOH; the Team Leads for Measles and Rubella, National Center for Surveillance and Control of Communicable Diseases, MOH; a measles and rubella epidemiologist from the District Public Health Authorities, MOH; the Director of the reimbursement department and an analyst at the National Health Insurance House (CNAS); and the Head of Country Office and a public health officer at the World Health Organization country office in Romania
Direct medical and nonmedical household
 Medical costs (e.g., consultation fees, laboratory tests and medications) and nonmedical costs (e.g., transport, food and lodging) paid out-of-pocket by cases and caregivers
 Household survey of 428 recent case-patients (within last 18 months) by using structured telephone interviews
Indirect household
 Workdays lost by cases and caregivers because of measles or rubella infections
 Household survey of 428 recent case-patients (within last 18 months) by using structured telephone interviews; 2012 Romanian national minimum wage of 700 Lei/month was used as proxy to quantify the value of lost workdays by patients and caretakers >18 y of age (8).
CRS cases healthcare provider
 All diagnostic services, inpatient and outpatient care reimbursements related to CRS diagnostic codes for identified CRS cases during timeframe
 Reimbursement data from National Health Insurance House (CNAS) covering all registered government healthcare providers for the 27 CRS cases identified from the time of the outbreak up to the date of data collection; reimbursement data were obtained for 18 (11 surviving and 7 who had died) of the 27 case-patients
CRS cases lifetime discounted indirect Workdays lost by CRS cases over assumed lifetime productive working years (18–63 y) 2012 Romanian national minimum wage of 700 Lei/month was used as a proxy to quantify the value of lost workdays by patients >18 y of age (8)

*CNAS, Casa Nationala de Asigurari de Sanatate; CRS, congenital rubella syndrome; MOH, Ministry of Health.

Main Article

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1Current affiliation: JoDon Consulting Group LLC, Atlanta, Georgia, USA.

2Current affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Page created: May 20, 2019
Page updated: May 20, 2019
Page reviewed: May 20, 2019
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